Parkinson's Patient muChipatara: Sei Kushayikwa Pa-Nguva Sinemet / Levodopa kana Kugamuchira Haldol Kunokonzera Kufa Kuoma¶

Vanhu vanopfuura 300,000 vaneParkinson's disease (PD) vanopinzwa muzvipatara gore rega rega nekuda kwekudonha, kutsemuka kwehudyu, kutapurira weti, mabayo, kana kuvhiyiwa semazuva ese, uye zvidzidzo zvekiriniki neParkinson's Foundation zvinoratidza kuti *vatatu pa4 varwere vari muchipatara vanorwara neParkinson vanotambura nemishonga inodzivirirwa Muwadhi yechipatara yakajairika kana Dhipatimendi reEmergency, mutemo wehukoti unobvumira "mishonga yemuromo yenguva dzose" kuti ishandiswe chero mukati me ** 1-kusvika-2-awa hwindo ** isati yasvika kana mushure menguva yakarongwa.09:00 AM / 13:00 PM / 17:00 PM / 21:00 PM), kana kuti anobata mapiritsi ese emukanwa zvachose ("NPO / Hapana nemuromo") uchimirira kuongororwa kwekumedza kana kuvhiyiwa.

Kune murwere ane mwero-kusvika-advanced chirwere cheParkinson ane uropi hwakarasikirwa ne80 muzana yemasikirwo ayo anogadzira dopamine, ** kunonoka kunwa carbidopa/levodopa (Sinemet, Rytary, Madopar, Stalevo, Prolopa) kunyange maminitsi 30 kusvika ku60 injodzi yezvokurapa.** Muawa imwe chete yedoro rapotswa, tsandanyama dzepahuro dzomurwere dzinooma kuvharika (dopamine-depletion dysphagia), zvichiita kuti vadzinge uye vapinze mate avo mumapapu avo (aspiration pneumonia), tsinga dzavo dzezwi dzinovharika kuti varege kushevedzera kuti vabatsirwe, uye muviri wavo unorwadza. Zvakatonyanya kuipa, nekukasira kumisa levodopa kwe12 kusvika kumaawa 48, kana kubaya murwere nechipatara chemazuva ese anti-nausea kana agitation mishonga inovhara dopamine (D2) receptors, senge ** haloperidol (Haldol, metoclopramide (Reglan), prochlorperazine (Compazine), kana promethazine (Phenergan), zvinokonzeresa Parkinsonism-Hyperpyrexia Syndrome (PHS), dambudziko reuropi-rignant-like dambudziko rine 40°C+ (104°F+) fivha, kuparara kwemisumbu (** rhabdomyolysis **), kukundikana kwetsvo, uye 4 kusvika ku20 muzana yehuwandu hwekufa. Kana murwere weParkinson akangoerekana aita kusimba, kupisa kwakanyanya, kusakwanisa kumedza, stridor, kana kuchinjwa kuziva, fonera nhamba yako yekukurumidzira.911 muUnited States neCanada, 112 muEuropean Union, 999 muUnited Kingdom) kana kubvunza yedu nhamba dze emergency directory. Nezve emergency emergency muchipatara chegeriatric, ona chipatara delirium uye kurudziro yekurapa kune vakuru, dysphagia: kukachidzwa pazvinwiwa zvitete, aspiration pneumonia, uye kuchengetedzwa kwekudya kwakakora,uye polypharmacy, kuwandisa kwemishonga, kupotsa doses, uye zvikanganiso zvemurongi wemapiritsi.

Ita izvi ikozvino¶

1. **Takura mishonga yose yemudiwa wako yeParkinson mumabhodhoro avo epakutanga akanyorwa mu pharmacy muEmergency Room, uye kumbira ER chiremba nokukurumidza nokuda kwe "Patient's Own Medication Self-Administration Order" kana "Nguva-Yakaoma Yakarongwa Order (Mukati 15 Maminitsi eMainitsi Ema15 eMainiti Echokwadi * Anowanzoita Mushonga Wemumba) yakawedzera-kuburitswa mafomu e carbidopa/levodopa (Rytary, Sinemet CR, entacapone, rasagiline, rotigotine zvigamba) mumuchina weER Pyxis, zvichitungamira kunonoka kwemaawa masere kunze kwekunge wauya nemabhodhoro epamba newe.
2. Simbisa kuti chiremba anobvuma anopinda muCarbidopa/Levodopa mukombuta yechipatara se "TIME-CRITICAL SCHEDULED MEDICATION" panguva chaiyo yewachi yemurwere (semuenzaniso, 07:30, 11:00, 14:30, 18:00, 21:30), HAKUNA sechipatara chakajairika "TID / QID" (09:00, 13:00, 17:00, 21:00). Pasi peCenters for Medicare & Medicaid Services (CMS) Hospital Conditions of Participation, mishonga yakanzi Time-Critical inofanira kupihwa mukati me15 kusvika 30 maminetsi enguva chaiyo yenguva, kudarika nguva yenguva yenyasha yekuyamwisa muchipatara yemaawa maviri.
3. ** Daidzira kuti mukoti weER uye mufemesi wepachipatara apinde zvachose "DRUG ALLERGY / ABSOLUTE CONTRAINDICATION ALERT" mune yemagetsi rekodhi rekodhi izvozvi kune YESE Dopamine-Kuvharira Zvinodhaka:** Haloperidol (Haldol), Metoclopramide (Reglan), Prochlorperazine (Compazine), Promethazine (Phenergan), Droperidol (Inapsine), Risperidone (Risperdal), Olanzapine (Zyprexa), uye Aripiprazole (Abilify). Kuisa mishonga iyi mu Allergy Field yemukombuta yechipatara inomanikidza kumira kwemagetsi kana mugari wehusiku kana anesthesiologist akaedza kuraira. Haldol nokuda kwedelirium kana Reglan / Compazine kuitira post-op nausea.
4. ** Kana chipatara chichiisa murwere pa "NPO (Hapana Nomuromo)" nokuda kwekuvhiyiwa, ER workup, kana kukundikana kwekumedza skrini, USAFANIRA kubvumira mishonga yavo ye dopamine kuti ingodarika. * Dana kuti chiremba pakarepo anyore imwe yemabhiriji matatu akachengeteka eNPO dopamine:
5. ** Sarudzo A: ** Isa chinguva ** Nasogastric (NG) Tube ** uye shandisa yakapwanyika ** pakarepo-kusunungurwa (IR) carbidopa / levodopa ** yakanyungudutswa mumvura (never crush extended-release CR/ER pills), OR
6. Sarudzo B: Kutonga Nemuromo Kuparadzanisa Carbidopa/Levodopa (Parcopa) inonyunguduka parurimi nemate, OR
7. Sarudzo C: Isa transdermal **Rotigotine Dopamine Agonist Skin Patch (Neupro) ** kuchengetedza baseline dopamine kukurudzira nepo ura usingasvikiki.
8. Kana murwere aine Deep Brain Stimulation (DBS) implant kana Duopa/Vyalev intestinal/subcutaneous pump, taurira ER chiremba uye chiremba anovhiya pakarepo. Usambobvumira monopolar electrocautery panguva yekuvhiyiwa pasina kuisa DBS neurostimulator mu **Surgery Mode **, usambobvumira a high-field Card Cards'sMRIs *Dbl's MRIs Device yeMRIs *Device Device pasina kuongorora ID *DB Device miganhu, uye usambodzima bhatiri reDBS kunze kwekunge wanyatso gadzirisa-induced dyskinesia.
9. ** Dhinda kana kuratidza iyo yepamutemo Parkinson's Foundation "Hospital Safety Guide / Medical Alert Card" (parkinson.org/hospital) uye tepi The Contraindicated Medication Sheet zvakananga pamusoro pemubhedha wechipatara.**

Muti wesarudzo: Kudzivirira murwere weParkinson kubva panguva yavanopinda muER¶

flowchart TD
    A["Murwere weParkinson's Disease Anosvika paChipatara ER kana kuti Surgical Pre-Op"] --> B["Danho 1: Ruoko Mukoti Mabhodhoro ePiritsi Emba + Dema 'Nguva-Yakakosha Chaicho-Maminiti Kushandiswa' (Mukati 15 Maminitsi eKumba Kurongwa)"]
    B --> C["Danho 2: Isa 'Haloperidol, Metoclopramide, Prochlorperazine, Promethazine, Risperidone, Olanzapine' muEMR ALLERGY / CONTRAINDICATION Alert Box"]
    C --> D{"Ko Murwere Anogona Kumedza Mapiritsi Ese Zvakachengeteka Iye Zvino?"}
    D -->|"Ehe: Kumedza Intact & Kwete NPO"| E["Ipa Chaiyo Dose Yepamba Panguva (Chengeta Mvura Yakatwasuka; Space Protein Meals 30-60 Mins Kure kubva kuLevodopa)"]
    D -->|"Kwete: Murwere 'NPO' Yekuvhiyiwa KANA Kudzipwa / Kutadza Kumedza Screen"| F{"Sei Vasingakwanisi Kumedza Mapiritsi Ese?"}
    F -->|"1. Kukachidzwa Nokuti Dose Yavo Yekupedzisira Levodopa Yakanonoka ('Off-State Dysphagia')"| G["Gamudzira Nemuromo Kuparadzanisa Carbidopa/Levodopa (Parcopa) kana Yakapwanyika IR Sinemet muApplesauce -> Edzaizve Kumedza 45 Mins LATER mu'ON' State"]
    F -->|"2. Strictly NPO for Bowel Obstruction, Intubation, kana Major Surgery"| H["Usambo Skip Dopamine: Isa NG Tube Yekupwanyika IR Carbidopa/Levodopa Kumiswa KANA Isa Transdermal Rotigotine Patch (Neupro)"]
    E --> I{"Ko Murwere Akave NeFivha Yakangoerekana Yaita >38.5°C, Bhodhi-Sekuoma Kwesimba, Kuvhiringidzika, kana Kukwidziridzwa CK?"}
    G --> I
    H --> I
    I -->|"EHE: Suspect Parkinsonism-Hyperpyrexia Syndrome (PHS)"| J["ICU EMERGENCY: Kurumidza tangazve Levodopa kuburikidza neNG Tube + IV Fluids + Active Kutonhora + IV Dantrolene / Oral Bromocriptine"]
    I -->|"NO: Yakagadzikana"| K["Simbisa kubva pamubhedha 3x / zuva nePT kudzivirira orthostatic hypotension uye deconditioning"]

Safe vs. VANHU AKARAMBWA mishonga yechipatara kune varwere vane chirwere cheParkinson¶

Dhinda kana ratidza iyi tafura yereferensi yekiriniki kune wese chiremba wechipatara, anesthesiologist, ER mukoti, uye wemishonga wepachipatara achichengeta mudiwa wako:

Nei kunonoka kwemaminetsi makumi matanhatu muCarbidopa / Levodopa kuchikonzera "Chipatara Chinodzika Kumhepo"¶

Vanamukoti vepachipatara vanochengeta mazana evarwere vezvekurapa kazhinji havazivi kuti nei mhuri yemurwere weParkinson ichivhunduka kana 10:00 AM Levodopa piritsi harisati rasvika 10:45 AM. Tsanangura iyo "Chipatara Dopamine Spiral" kumukoti wepasi uye mukoti anochaja nekukurumidza:

1. The Shrinking "Therapeutic Window" muAdvanced Parkinson's¶

Mukutanga kwechirwere cheParkinson, uropi huchiri nehupenyu hwakakwana huripo huripo hwekuchengetedza dopamine uye buffer piritsi ranonoka kwemaawa matatu kana mana. Panosvika gore rechishanu kusvika kugumi rechirwere cheParkinson, masero ekuchengetedza iwayo anenge apera: kukwanisa kwemurwere kufamba, kutaura, uye kumedza kunotsamira pahafu yeupenyu yeplasma yemaminetsi makumi mapfumbamwe epiritsi rega rega relevodopa.

Kana chipatara chikanonotsa dosi nemaminitsi makumi matanhatu, zviitiko zvina zvine njodzi zvinoitika mukukurumidza kutevedzana:

1. **Miniti 45, "Kupfeka-Kubvisa" Kubvunda, Kushushikana, uye Kurwadza Dystonia: ** Dopamine mazinga mu striatum yekudonha. Murwere anotanga kudengenyeka kwekuzorora kwechisimba, kuvhunduka kwakanyanya kwemukati uye dysphoria (chiratidzo chemakemikari dopamine-drop chinowanzoonekwa zvisiri izvo nevashandi vechipatara se "psychiatric agitation"), uye kurwadziwa kunorwadza kwemakumbo ezvigunwe, mhuru, uye mitsipa.
2. Miniti 60, "Off-State Dysphagia" (Kumedza Nechando): Mitsipa yepharyngeal neyesophageal inoda dopamine kuti ibatanidze kumedza reflex. Kana murwere achinge adonhera ku**"OFF" state**, haachakwanisa kumedza zvakanaka, kureva kuti mukoti paanozononoka kufamba mushure memaminitsi makumi mapfumbamwe nekapu yemapiritsi, murwere anobva adzipwa nemapiritsi.
3. Minute 75, The Speech Therapy "NPO Trap": Nekuda kwekuti murwere akakosora achiedza kumedza mapiritsi avo anonoka kumedza "OFF", mukoti anoisa murwere pa "Strict NPO (Nothing by Mouth)" ndokurayira Speech-Language Pathology (SLP) kumedza kuongororwa mangwana. Nekuti murwere ava NPO, mukoti anonyima 14:00 PM, 18:00 PM,uye 22:00 PM levodopa doses zvakare.
4. ** Awa 12 kusvika 24, Complete Akinetic Freeze, Aspiration Pneumonia, uye Delirium:** Kunyimwa dopamine yese kwemaawa gumi nemaviri, murwere anotadza kufamba zvachose ("chando pamubhedha"), anoshuvira kuvharirwa kwemukanwa mumapapu avo, anotanga pneumonia-inotorwa muchipatara nehuropi uye delipyrexia. Syndrome**.

2. Nzira yekupwanya sei "Swallow Screen NPO Trap" padivi pemubhedha¶

Kana mukoti kana chiremba akati: "Baba vako vakakosora pamvura yakatetepa panguva yekumedza skrini yeER, saka ivo NPO uye havagone kuva nemapiritsi avo eSinemet," pindira nekukasira nezvitatu izvi zvekiriniki:

• Mutemo 1 (Usamboedza Kumedza Kwemurwere weParkinson Kana Vari Mu "OFF" State): Kuongorora kumedza kwemurwere weParkinson apo anenge anonoka nemaawa matatu kuti levodopa aite vimbiso yekuti achakundikana. Kumbira chiremba kuti ape ** imwe yero yeOlly Disintegrating Carbidopa/Levodopa (Parcopa)** parurimi, kana **yakapwanyika Pakarepo-Kusunungurwa (IR) Carbidopa/Levodopa yakasanganiswa mu1 teaspoon yeapurosauce gobvu kana pudding **, mirira 45 maminetsi kuti dopamine ishandure mhasuru dzepahuro dzemurwere "ON", uye zve ita Speech-Language Pathologist kuita kumedza e.
• Mutemo 2 (Kutsiviwa Kwakachengeteka Kana Mapiritsi Akawedzerwa-Kusunungurwa Haagone Kupwanyika):
• ** Usambopwanya kana kutsenga Yakawedzerwa-Kuburitswa Carbidopa/Levodopa (Sinemet CR / ER)** kana kutsenga Yakawedzerwa-Release Capsules (Rytary) kana murwere asingakwanisi kumedza mapiritsi ose. Apo Rytary capsules inogona kuvhurwa zvakanaka uye mabhero asaswa pamaapuroauce pasina kutsenga mabhero, Sinemet CR mahwendefa anofanira kuchinjwa kuti ave muyero wakaenzana we Immediate-Release (IR) Carbidopa/Levodopa (kazhinji kuderedza milligram yese yedosi ne25 kusvika 30 muzana kuti iwane yakakwirira IR bioavailability uye dosing zvishoma kakawanda) isati yapwanyirwa NG tube.
• Mutemo wechitatu (Chaizvoizvo Levodopa-ku-NG-Tube uye Rotigotine Patch Shanduko Yekuverenga):
• Kana murwere weParkinson akanyatsoita NPO yekuvhiyiwa kwemudumbu, kuvharika kwebowel, kana mechanical ventilation muICU, mufesi wechipatara uye neurologist anofanira kuverenga ** Levodopa Equivalent Daily Dose (LEDD)** saka zero maawa ekuvhara dopamine anorasika:
• Nasogastric (NG) Tube Liquid Suspension Protocol: Nekukurumidza-Kuburitswa (IRCarbidopa/Levodopa25/100 mg) mapiritsi anonyungudika nekukurumidza mukati 30 mL (1 fl oz) yekamuri-tembiricha yemvura yemupombi (kana carbonated mvura/ascorbic acid solution) mukati me5 maminetsi ekutenderera zvinyoro nyoro pasina kuda kupwanya kukuru. Geza iyo NG chubhu ne 30 mL yemvura pamberi uye mushure mekuisa iyo yakanyungudutswa levodopa, uye sunga iyo NG chubhu kusveta kweinenge 30 kusvika 45 maminetsi mushure memushonga wega wega kuitira kuti dumbu ritore mushonga.
• Transdermal Rotigotine (Neupro) Patch Bridge (Apo Uturu Husingagoni Kushandiswa): Kana murwere ane ileus yakaoma mitezo, kuvharika kwehuta huduku, kana kuti ichangobva kuitika gastrointestinal anastomosis apo kunyange NG-tube fluid haigoni kubatwa, bvunza chiremba wetsinga kuti aise 24-awa Transdermal Rotigotine Dopamine Agonist Patch (Neupro, inowanikwa mu 2 mg, 4 mg, 6 mg,uye 8 mg/24 hr zvigamba) kuchenesa ganda pabendekete, ruoko rwepamusoro, dumbu, kana chidya (nzvimbo dzinotenderera zuva nezuva uye kubvisa aluminium-backed patch pamberi peMRI scan kudzivirira kutsva kweganda).
• Chenjerai Kuvharisa Tube-Kudyisa Mapuroteni Kuvharisa Levodopa: Zvokudya mamino acids (protein) kwikwidzana zvakananga ne*levodopa pakutakura nemudhuri weura uye nekuyambuka chivharo cheropa-uropi (large neutral amino acid transporter) Kana mudiwa wako akaiswa pane inoenderera 24-awa mvura **enteral tube feedings ** (Jevity, Osmolite, Ensure) kuburikidza ne NG kana PEG chubhu, mapuroteni akakwirira ari muchubhu feed achavhara 70 muzana ye levodopa yavo yakapwanyika kubva pakusvika kuuropi yavo, ichivasiya vakaoma kunyange zvazvo vari kuwana mapiritsi avo. Bvunza chiremba uye nyanzvi yezvekudya kuti ** bata chubhu yekudya kwemaminetsi makumi matanhatu PASI uye 30 kusvika 60 maminetsi PASHURE pese yakarongwa levodopa dose ** (kana chinja kune bolus masikati/nocturnal cyclic tube feeds yakarongwa kutenderedza levodopa mahwindo).

Deep Brain Stimulation (DBS) uye Duopa/Vyalev pombi emergency muchipatara¶

Makumi ezviuru zvevanhu vakura vane chirwere cheParkinson vanovimba nekudyarwa Deep Brain Stimulation (DBS) neurostimulators (yakagadzirwa neMedtronic, Abbott/St. Jude, kana Boston Scientific) kana pombi dzinoramba dzichiiswa (Duopa carbidopa/levodopa kana PEG-Vya gel) kana PEG-Vya gel. Produodopa** 24-hour subcutaneous foscarbidopa/foslevodopa infusion). Kana murwere ane chimwe chezvishandiso izvi achipinda muDhipatimendi reEmergency kana Operating Room, vashandi vechipatara vasingazivi hardware vanogona kukanganisa kukuvara kwehuropi kana acute dopamine kubvisa dambudziko.

1. Mitemo mitatu yakaoma yekuchengetedzwa kwechipatara yeDeep Brain Stimulation (DBS) implants¶

2. Chii chekuita kana Duopa (PEG-J) kana Vyalev (Subcutaneous) Infusion Pump ikamira kushanda muER¶

• Usambobvumira mukoti wepachipatara kudzima pombi yeDuopa kana Vyalev pasina bhiriji rekununura remuromo/NG levodopa:
• Murwere ari pa Duopa (carbidopa/levodopa enteral suspension) pombi kana Vyalev (foscarbidopa/foslevodopa) subcutaneous pombi inogamuchira 100 muzana ye dopamine yavo yezuva nezuva inoenderera kuburikidza nepombi iyoyo.
• Kana iyo PEG-J intestinal chubhu yakavhara/inorasa, kana pombi ikapera makaseti muER, kana mukoti akabvisa pombi yeCT scan okanganwa kuitangazve, mazinga eplasma levodopa emurwere anodonha kusvika zero mukati 60 maminetsi.
• Immediate Rescue Protocol: Geza chubhu yakavharwa yeDuopa PEG-J nemvura inodziya uchishandisa sirinji yeLuer-lock (never push against hard resistance) Kana pombi kana kaseti isingawanikwe muchipatara chemishonga, chiremba ** anofanira kukurumidza kuverenga nguva yemurwere zuva rose + mangwanani bolus milligram dose ye levodopa ** uye shandisa yakaenzana ** oral kana NG-tube Pakarepo-Release Carbidopa / Levodopa maawa maviri kusvika matatu kumativi ose emhuri inounza kubva kumba.

Kuziva uye kurapa "Parkinsonism-Hyperpyrexia Syndrome" (PHS / Dopamine Kubvisa Dambudziko)¶

Parkinsonism-Hyperpyrexia Syndrome (PHS), inonziwo Akinetic Crisis kana Neuroleptic Malignant-Like Syndrome (NMLS), ndiyo inouraya zvakanyanya tsinga dzechimbichimbi muchirwere cheParkinson. Inokonzerwa apo mishonga yemurwere inonzi dopaminergic inomira pakarepo kana kuderedzwa kwemaawa 12 kusvika ku72 (panguva yeNPO, kuvhiyiwa kwebowel, kubvumirwa ICU, kana kurasikirwa kwemapiritsi emabhodhoro), apo utachiona kana kupera simba kwemvura kunovhara kunyura, kana kuti dopamine-blocking drug (Haldol, Reglan) inopiwa.

flowchart TD
    A["Murwere waParkinson Akapotsa Levodopa kwe> Maawa gumi nemaviri KANA Akagamuchira Dopamine-Kuvharisa Mushonga (Haldol / Reglan / Compazine)"] --> B["Tarisa kune zvina Zviratidzo zveParkinsonism-Hyperpyrexia Syndrome (PHS)"]
    B --> C["1. Yakanyanyisa 'Lead-Pipe' Muscular Rigidity & Akinesia (Haikwanisi kufambisa maoko nemakumbo, kutaura, kana kumedza)"]
    B --> D["2. Hyperthermia / High Fever (38.5 ° C kusvika 41.0 ° C + / 101.3 ° F kusvika 105.8 ° F +) Haitsanangurwi neKutapukirwa Kwega"]
    B --> E["3. Autonomic Instability (Wild swings in blood pressure, tachycardia>110 bpm, dikita rakanyanyisa)"]
    B --> F["4. Altered Consciousness (Stupor, severe delirium, mutism, coma) + Yakakwira Serum Creatine Kinase (CK>1,000-10,000 U/L)"]
    C --> G["IMMEDIATE ICU EMERGENCY PROTOCOL"]
    D --> G
    E --> G
    F --> G
    G --> H["1. Pakarepo Dzosa Dopamine: Isa NG Tube uye shandisa chaiyo purogiramu yepamba yeCrushed Immediate-Release Carbidopa/Levodopa (kana Rotigotine Patch / Apomorphine)"]
    H --> I["2. Aggressive IV Crystalloid Hydration (Kudzivirira Rhabdomyolysis Kidney Failure) + Evaporative Cooling Blankets (Antipyretics seTylenol HAIshande pamhasuru-rigidity fever)"]
    I --> J["3. Shandisa IV Dantrolene Sodium (1 kusvika 2.5 mg / kg IV) kuti uzorodze skeletal muscle rigidity + Oral / NG Bromocriptine (2.5 kusvika 10 mg TID)"]

• ** Nei Tylenol (Acetaminophen) Isingaregi FHS Fever: ** The 40°C (104°F) fivha muParkinsonism-Hyperpyrexia Syndrome inogadzirwa ne hypothalamic dopamine depletion uye yakanyanyisa, isingachinjike skeletal muscle contraction mumuviri wose, kwete kungozvimba cytokines. Standard fever reducers (acetaminophen / ibuprofen) ichakundikana kunze kwekunge boka ** pakarepo kudzorera levodopa kuburikidza ne NG tube **, inotonhorera murwere kunze nemagumbeze anotonhorera / ice packs, inopinza hukasha hweIV mvura kuti ibudise myoglobin kubva muitsvo, uye inotungamirira ** IV Dantrolene ** (muscle relaxant) kana ** Bromocriptine agonist) ** (dopamine agonist).

Nhamba dzenharaunda dzechimbichimbi uye zvirongwa zveagency¶

Shandisa izvi zviri pamutemo neurology, kuchengetedzwa kwevarwere vechipatara, uye mitsara yekumisikidza yekukurumidzira kuchengetedza murwere wechipatara Parkinson munharaunda yako:

• Nyika dzakabatana:
• Emergency EMS / Acute Rigidity kana Airway Choking: Call 911.
• Parkinson's Foundation Helpline (Nurse & Hospital Safety Specialists): Fonera 1-800-4PD-INFO (1-800-473-4636) kana kudhawunirodha Hospital Safety Kit kuparkinson.org/hospital. Kana chiremba wechipatara akaramba kuodha nguva-yakakosha levodopa kana kuraira contraindicated dopamine blocker, Parkinson's Foundation Helpline inogona kupa zviri pamutemo-anoongororwa nevezera rako mapepa ekiriniki emuchipatara wako uye anokubatanidza nechipatara ** Mumiriri weMurwere / Mukuru Chiremba Mukuru**.
• ** American Parkinson Chirwere Association (APDA):** Fonera 1-800-223-2732 (apdaparkinson.org)
• ** Joint Commission / CMS Hospital Patient Safety Complaints:** Kana chipatara chikanyima mushonga weParkinson wenguva-yakakosha zvisinei nezvikumbiro zvemhuri, kumbira kuti utariswe nekukasika ne **Mutariri weNjodzi Yechipatara / Mumiriri weMurwere ** uye In-House Neurology Consult Service.
• Kanadha:
• Emergency: Call 911.
• Parkinson Canada ("ACT on Time®" Hospital Kit): Fonera 1-800-565-3000 kana kushanya parkinson.ca kudhawunirodha ITA paTime® kadhi yekuzivisa mishonga yechipatara uye yakachengeteka/isina kuchengetedzeka anti-kusvotwa mushonga chati (ichicherekedza kuti muCanada, Domperidone [Motilium] uye Ondansetron [Zofran] ndiwo mishonga miviri inodzivirira kusvotwa kuvarwere veParkinson, apo Maxolon [metoclopramide] uye Stemetil [prochlorperazine] inorambidzwa zvachose).
• Nyika dzakabatana:
• Emergency: Call 999 (kana 111 yekukurumidza zano reNHS).
• Parkinson's UK ("Get It On Time" Campaign & NHS Electronic Prescribing Mandate): Fonera Parkinson's UK Helpline pa 0808 800 0303 (parkinsons.org.uk) Pasi pe NICE Guideline NG71 (Parkinson's disease muvakuru) uye NHS England Patient Safety Alerts, vose vanovimba nechipatara cheNHS vanorayirwa kuisa mishonga yeantiparkinsonian (co-careldopa / Sinemet, co-beneldopa / Madopar, rotigotine zvigamba, apomorphine) se Time-Critical Medications inopihwa mukati me30 maminetsi echirongwa chepamba chemurwere, kubvumidza Kuzvitonga Kwemishonga (SAM) pawadhi kana ichikwanisa, uye kuonana ne Hospital Parkinson's Disease Nurse Specialist (PDNS) mukati memaawa makumi maviri nemana ekubvumidzwa.
• European Union:
• Emergency: Call 112. Kumbira chiremba wepachipatara anobvuma kuti abate timu yechipatara chetsinga nekukasika kuti atendeuke nemuromo Madopar / Sinemet kupiritsi rinonyungudika rinoparara (Madopar Dispersible / LT) kuburikidza ne nasogastric chubhu kana ** Rotigotine (Neupro) transdermal patch ** kana murwere akaitwa NPO (à jeun / nüchtern).
• Australia neNew Zealand:
• Emergency: Call 000 (Australia) kana 111 (Nyuzirendi).
• Parkinson's Australia ("Iwane Panguva" Chipatara Protocol): Fonera 1800 644 189 (parkinsons.org.au) kana Parkinson's New Zealand pa 0800 473 4636 (parkinsons.org.nz) MuAustralia neNew Zealand, ** Maxolon (metoclopramide) ** uye ** Stemetil (prochlorperazine) ** inoshandiswa zvakanyanya seyokutanga ambulensi uye ED anti-emetics; ** udza vanobatsira varwere muamburenzi vasati vagadzira sirinji yekurwisa-nausea kuti murwere ane chirwere cheParkinson uye anofanira KUPIWA Ondansetron CHETE.ZofranDomperidone ()Motilium)**.
• India neAsia-Pacific:
• Emergency: Call 112 kana 108. Pakubvuma murwere weParkinson Kutora Syndopa (levodopa/carbidopa) kuchipatara cheIndia, unza mitsetse yemba yakananga kuICU/wadhi chiteshi chevakoti uye uraire chiremba anogara kuti asambopa Perinorm (metoclopramide), **Stemetil (prochlorperazine) **, kana Serenace (haloperidol); chikumbiro Emset / Ondem (ondansetron) kana Domstal (domperidone) yekurutsa uye Qutipin (quetiapine) kana sedation ichidikanwa.

Mibvunzo inowanzo bvunzwa¶

Sei zvine njodzi kana chipatara chikapa Sinemet yemubereki wangu (carbidopa/levodopa) kweawa kunonoka?¶

Mune chirwere cheParkinson chepakati-kusvika-mberi, uropi hwakarasikirwa neneuroni zhinji dzinogadzira uye kuchengeta dopamine, zvichireva kuti murwere anovimba zvakananga nepfupi 90-maminetsi hafu yehupenyu hwega yega yakarongwa carbidopa/levodopa piritsi kufamba, kutaura, uye kumedza. Kana mukoti wepachipatara akanonotsa kunwa kunyange maminetsi makumi mana nemashanu kusvika makumi matanhatu, murwere anorovera padanho rekuti "OFF": tsandanyama dzehuro yavo dzinooma zvekuti vanodzipwa nemate avo uye havachakwanisa kumedza mapiritsi, muviri wavo unovharira mukuoma kunorwadza, uye kurovha kwenguva refu kunogona kukonzera kuuraya Parkinsonism-Hyperpyrexia Syndrome.

Ndeipi mishonga yechipatara isingambofanirwe kupihwa kumurwere ane chirwere cheParkinson?¶

Murwere ane chirwere cheParkinson haafanire kupihwa mishonga inoyambuka ropa-brain barriers uye inovhara pakati D2 dopamine receptors. Iwo maviri makirasi ane njodzi muchipatara ndeye dopamine-inovharira anti-nausea zvinodhaka, kunyanya Metoclopramide (Reglan / Maxolon), Prochlorperazine (Compazine / Stemetil), Promethazine (Phenergan), uye Droperidol, uye yakajairika kana yakakwirira-potency atypical antipsychotics yakapihwa kuchipatara delirium, kunyanya Hadolloperidalone (Hasperidlone) (Zyprexa), uye Aripiprazole (Abilify). Ita kuti mukoti weER apinze mishonga iyi yese mubhokisi remuchipatara reAllergy/Contraindication paanenge asvika.

Ndeapi mishonga yekurwisa kusvotwa uye kubvongodza ZVINOGONA kune murwere ari muchipatara Parkinson?¶

Nekuda kwekusvotwa uye kurutsa, mushonga wechipatara wakachengeteka ndeye Ondansetron (Zofran), inovhara serotonin 5-HT3 receptors pane dopamine receptors (chinyorwa: usasanganise Zofran ne apomorphine), kana Domperidone munyika dziri kunze kweUS. Kana murwere wechipatara Parkinson akaita delirium yakaoma, kuona, kana kubvongodzwa kusingagone kudzikamiswa nemaitiro asiri ezvinodhaka, iyo chete yakachengeteka antipsychotic sarudzo iPimavanserin (Nuplazid), yakaderera-dose Quetiapine (Seroquel), kana Clozapine (Clozaril), nekuti haivharidzi striatal motor dopamine receptors.

Chii chinofanira kuita chipatara kana mubereki wangu ane Parkinson akaiswa pa "NPO (Nothing by Mouth)" nokuda kwekuvhiyiwa kana kuti kumedza kwakakundikana?¶

Usambobvumira timu yechipatara kungobata kana kusvetuka mishonga yeParkinson nekuti murwere iNPO. Kana murwere atadza chidzitiro chekumedza nekuti levodopa yavo yakanonoka, kumbira chiremba kuti ape Olly Disintegrating Carbidopa/Levodopa (Parcopa) parurimi kana kuti akapwanyiwa Immediate-Release Sinemet mu teaspoon yeappleauce, mirira maminitsi 45 kuti tsandanyama dzehuro dzidzokere shure "ON," uye edzazve kumedza kwavo. Kana murwere akanyatsoita NPO yekuvhiyiwa kana intubation, chiremba anofanira kuisa imwe nguva nasogastric (NG) tube kuti ape yakapwanyika pakarepo-kusunungurwa carbidopa / levodopa kumiswa panguva, kana kushandisa transdermal Rotigotine (Neupro) dopamine agonist ganda chigamba.

Chii chinonzi Parkinsonism-Hyperpyrexia Syndrome (PHS), uye ndinozviziva sei?¶

Parkinsonism-Hyperpyrexia Syndrome (inonziwo Akinetic Crisis kana Neuroleptic Malignant-Like Syndrome) injodzi yehutano inotyisa inokonzerwa apo levodopa yemurwere weParkinson inomira pakarepo kwemaawa 12 kusvika ku48 kana kuti pavanopiwa dopamine-blocking drug seReglan Haldol. Inotaridzika zvakafanana neNeuroleptic Malignant Syndrome: yakanyanyisa bhodhi-yakafanana nemhasuru kusimba mumuviri wese, kupisa kwakanyanya kunopfuura 38.5 kusvika 41 madhigirii celsius (101.3 kusvika 105.8 madhigirii Fahrenheit), kukurumidza kurova kwemoyo uye kushanduka-shanduka kweropa, stupor kana coma, uye high blood breakdown Creatine Kina. Zvinoda kukurumidza kutarisirwa kweICU, kutangazve levodopa kuburikidza ne NG chubhu, IV hydration, magumbeze ekutonhodza, uye IV dantrolene kana bromocriptine.

Sei mukoti asingakwanisi kupwanya mapiritsi emubereki wangu Akawedzerwa-Release Sinemet CR kana kusanganisa levodopa nepamusoro-protein tube feedings?¶

Kupwanya Kuwedzerwa-Kusunungurwa kweCarbidopa / Levodopa tablet (Sinemet CR / ER) inoparadza matrix ayo anononoka, achirasa muyero wose kamwechete uye kukonzera dyskinesia inokanganisa inoteverwa nekuparara kwemotokari kamwe kamwe; pachinzvimbo, chiremba anofanira kushandura kurongeka kuImmediate-Release (IR) Carbidopa/Levodopa mapiritsi asati apwanya. Uyezve, mapuroteni ezvokudya (amino acids) anokwikwidzana zvakananga ne levodopa kuti atore mumatumbo uye nechepakati peropa-brain barrier; kana murwere ari kuenderera mberi mvura yeprotein chubhu kudya, chikafu chechubhu chinofanira kumbomira kwemaminetsi makumi matanhatu pamberi uye 30 kusvika 60 maminetsi mushure meyese levodopa dose kuitira kuti mushonga usvike kuuropi.

Mazano anoenderana¶

• Chipatara delirium uye kumiririra kurapwa kune vakuru
• Dysphagia: kukachidzwa pazvinwiwa zvitete, aspiration pneumonia, uye kuchengetedzwa kwekudya kwakakora
• Polypharmacy, kuwandisa kwemishonga, kupotsa dosi, uye zvikanganiso zvemurongi wemapiritsi
• Kamwe kamwe kuvhiringidzika muvakuru: kunyarara UTI urosepsis vs. sitiroko uye nei vakwegura varwere vasina fivha

Nzvimbo uye nhungamiro yepamutemo¶

• Parkinson's Foundation: Hospital Care Recommendations & Hospital Safety Guide: Time-Critical Dopaminergic Dosing, Contraindicated Antiemetics/Antipsychotics, uye Perioperative NPO Bridge Protocols (parkinson.org/hospital).
• UK National Institute for Health and Care Excellence (NICE): *NICE Nhungamiro NG71: Parkinson's Disease in Adults, Acute Hospital Admission, Prohibited Abrupt Levodopa Withdrawal, uye NPO Rotigotine / NG Tube Conversion *.
• American Academy of Neurology (AAN) & International Parkinson uye Movement Disorder Society (MDS): *Clinical Practice Guidelines for the Recognition uye ICU Management yeParkinsonism-Hyperpyrexia Syndrome (Akinetic Crisis) *.
• Institute for Safe Medication Practices (ISMP): * Targeted Mishonga Kuchengetedzwa Maitiro Akanakisisa eZvipatara: Kudzivirira Kusiiwa Kwenguva-Yakakosha Carbidopa / Levodopa uye Kuvhara Contraindicated D2 Antagonists *.
• American Geriatrics Society (AGS): * Yakagadziridzwa AGS Beers Criteria® yeInogona Kusakodzera Kushandisa Mishonga muVakuru Vakwegura (Kudzivisa Kwakasimba kweTypical/Atypical Antipsychotics uye Metoclopramide muParkinson's Disease)*.